This invention relates to a hand surgery operating table, for the rapid and quick securing, as well as accurate positioning of a hand for surgery.
It is well-known that in the course of surgery, an operating surgeon performs the more demanding operations with the aid of assistants. This also means that within a relatively small area, the activity of four to six and possibly more hands has to be coordinated. However, the space available for this purpose is relatively small and thus the crowding together of many hands makes the operations more difficult. In addition, in the course of an operation certain instruments or certain tissues or arteries etc. associated with the area to be operated on must be maintained in accurately set positions for a long time and, under the above-described circumstances, this is not realized in practice.
A particularly difficult problem is presented in the course of hand surgery when performed on a so-called hand surgery table. Since a human hand is a collection of very small and complicated structures, the use of magnifiers or even operating microscopes has become ever more widespread for such operations. Accordingly, it is more important than ever that the hand, as the "workpiece" of hand surgery, should be positioned and secured accurately. Yet to this day, hand operations are performed on hand surgery operating tables which, in their essence, do not differ from ordinary operating tables.
Essentially, hand surgery operating tables consist of a quadrangular, planar plate connected to an operating table. The operation on a hand placed on this table is generally performed by the operating surgeon with the aid of assistants. In the case of more serious operations, one assistant attempts to fix the hand in a suitable position, while another assists in the exposure following incision by using retractors. Such operations may often take several hours and they are generally performed in a position non-coplanar with the plane of the hand surgery operating table; the assumption of a fixed position of the hand and of the fingers should be ensured by the assistants, but the required total lack of movement is clearly and manifestly illusory in the above-described circumstances.
In more recent times several attempts have been made for modernizing hand surgery operating tables to overcome the above-described evident contradictions. In simple construction, the hand surgery operating table was of a form pivotable about a predetermined angle and grooves, conforming to the shape of the fingers, were provided in its top surface. The fingers could be fixed in the recesses or grooves by means of rubber rings. In a further-developed variant of this construction, hooks recessed into the surface have been used to secure the fingers.
This method of securing a hand in position is fairly primitive and since operations always take place in three dimensioned, the planar plate fixing the hand cannot assure the required hand positioning, even if it is pivotable.
To solve the tasks of fixing a hand and fingers in position and to achieve satisfactory retraction for exposing the edges of the incision, constructions have also been proposed which consist essentially of a metal sheet shaped in the contour of a hand and having a serrated or toothed edge. Here also the hand and the fingers are fixed with the aid of slits and rubber strips. To open up the edges of the incision, hooks fixed on ball-and-chain units have been employed. The length of the chains can be regulated by hooking in at the serration at the edges of the sheet. In order to allow the clamping to be performed in "space", the construction is provided with chain-raising devices that can also be fixed to the toothed edges of the sheet.
In practice this construction did not afford significantly greater advantages than those described above. The hooking can only be performed slowly and in a cumbersome manner and, in spite of it, the desired positions can only partially be pre-set. Thus, for instance, no retraction is possible in an upward direction. It is not possible to adjust the pivot or to turn the hand.
A so-called lead "hand" has also been used in many places for hand operations. This "hand", made from lead sheet, is an auxiliary device cut into the shape of a hand to which the hand and its fingers can be fixed by means of thread, bandage, rubber rings or, in given cases, by lugs formed in the plate. The adjustment of the position of the hand and fingers takes place by bending the lead sheet about while the limb to be operated on is itself fixed by slings operated by the assistants.
Manifestly this solution does not assure the conditions required for a disturbance-free performance of operations and, in addition, the lead "hands" wear out relatively quickly, i.e. they break to pieces. Generally after performing a few operations such lead "hands" are so bent that they cannot be used any further.
As we have seen, the above-listed auxiliary devices cannot assure the optimum positioning of the limb to be operated on, not even in a static condition. Therefore, it cannot be expected that these constructions should be suitable for adjusting the hand to several different positions, as is often required in certain operations, i.e. to change its position or orientation. The fact that these constructions have not become widespread in practice can be ascribed to the above-mentioned disadvantages and, that is why, in the main, hand operations are still performed on a simple table.